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Comparative Hemolytic Effects of Ex Vivo Lung Perfusion Perfusates: An In Vitro Blood Loop Approach.

Chris H H Chan1, Asma F Farooqui1, Christopher Tan1

  • 1Innovative Device & Engineering Applications Lab, the Texas Heart Institute at Baylor College of Medicine, Houston, Texas, USA.

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Summary

Leukocyte depletion in ex vivo lung perfusion (EVLP) reduces blood hemolysis and lactate buildup, improving donor lung viability. An in vitro blood loop effectively assesses perfusate quality for better EVLP outcomes.

Keywords:
EVLPhemolysislactatemock EVLP loopsperfusates

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Area of Science:

  • Transplantation immunology
  • Cardiovascular and respiratory physiology
  • Biomaterials science

Background:

  • Ex vivo lung perfusion (EVLP) is crucial for assessing and optimizing donor lungs, expanding the donor pool.
  • Elevated hemolysis and lactate in EVLP perfusate can negatively impact graft viability.
  • Optimizing perfusate composition is key to enhancing EVLP efficacy and clinical outcomes.

Purpose of the Study:

  • To evaluate the hemocompatibility of whole blood (WB) versus leukocyte-depleted (LD) blood perfusates in a mock EVLP model.
  • To assess the impact of perfusate type on hemolysis and lactate accumulation during simulated EVLP.
  • To determine the suitability of an in vitro blood loop for perfusate quality assessment in EVLP.

Main Methods:

  • Comparison of WB and LD blood perfusates in identical mock EVLP loops for 10 hours at 37°C.
  • Inclusion of saline-washed red blood cells (RBC) as a reference perfusate.
  • Standardization of hematocrit to 19.1% ± 1.3% and monitoring of hemolysis and lactate levels.

Main Results:

  • Whole blood (WB) perfusate showed significantly higher rates of hemolysis and lactate accumulation compared to leukocyte-depleted (LD) and RBC groups.
  • The normalized index of hemolysis at 10 hours was significantly greater in the WB group than in LD and RBC groups.
  • No significant differences in hemolysis or lactate accumulation were observed between LD and RBC perfusates.

Conclusions:

  • Leukocyte depletion in blood-based EVLP is associated with reduced hemolysis and lactate accumulation, potentially improving graft viability.
  • The in vitro blood loop model provides a viable method for evaluating perfusate quality and optimizing EVLP protocols.
  • Findings suggest that LD blood is a more hemocompatible perfusate for EVLP compared to WB.